1. Chapter 2: Health Care Organization and Administration in Athletic Training

2. System of Healthcare Management
Strategic Plan Development
Determine why there is need for such a program
Determine function of program and what the goals should be
Decision of administrators will determine extent of health care program in athletic training
Develop written mission statement to focus direction of program

3. Strategic Plan Development (cont.)
Strategic plan development must include administrators, other allied healthcare providers, student-athletes, coaches, physicians, athletic trainers, parents and community health leaders
Ongoing process that reviews strengths and weaknesses of program

4. Development of Policy & Procedures Manual
Creation of policies and procedures for all involved in health care
Policies = clear written out statements of basic rules
Critical element for operation of athletic training clinic
Procedures = describe the process

5. Issues Specific to Athletic Training Program Operations
Scope of Program
Who will be served by program?
Athlete: to what extent and what services will be rendered (systemic illness, musculoskeletal injuries)
Institution: who else can be served medically and educationally and what are the legalities
Community: outside group and community organizations with legalities again being an issue

6. Providing Coverage Facility Personnel Coverage Sports Coverage
Appropriate coverage of facility and sports
Setup of treatments, rehabilitation, game and practice coverage vary
Sports Coverage
Certified athletic trainer should attend all practices and games
Different institutions have different levels of coverage based on personnel and risks involved with sports

7. Hygiene and Sanitation
Athletic Training Clinic
Rules concerning room cleanliness and sanitation must be set and made known to population using facility
Operation should abide by policies set forth by OSHA
Examples
No equipment/cleats in the athletic training room
Shoes off treatment tables
Shower prior to treatment
No roughhousing or profanity
No food or smokeless tobacco

8. Division of responsibilities Maintenance crew
Cleaning responsibilities should be addressed appropriately by athletic training staff and custodial staff
Division of responsibilities
Maintenance crew
Sweep floors daily, clean and disinfect sinks and tubs, mop hydrotherapy room, empty waste baskets
Athletic Training staff
Clean treatment tables, disinfect hydrotherapy modalities daily, clean equipment regularly

9. Gymnasium (general issues concerning facility and equipment cleanliness)
Cleaning of gymnasium floors
Drinking fountain and shower/locker facility disinfecting
Mats cleaned daily (wrestling)
Equipment and clothing
Proper fitting equipment
Frequent clothing and equipment laundering
Appropriate equipment for weather conditions
Use of clean dry towels and equipment daily

10. Athlete Promotion of good health and hygiene is critical
Prompt injury and illness reporting
Follow good living habits
Showering after practice
Avoid sharing clothes and towels
Exhibit good hygiene practices
Avoid common drinking sources
Avoid contact with athletes with contagious disease or infection

11. Emergency Telephones
Accessibility to phones in all major areas of activity is a must
Should be able to contact outside emergency help and be able to call for additional athletic training assistance
Radios, cell and digital phones provide a great deal of flexibility

12. Budgetary Concerns Size of budget
Different settings = different size budgets and space allocations
Equipment needs and supplies vary depending on the setting (college vs. secondary school)
Continuous planning and prioritizing is necessary to effectively manage monetary allocations to meet programmatic goals

13. Supplies Expendable Non-expendable
Involves supplies that cannot be reused- first aid and injury prevention supplies
Non-expendable
Re-useable supplies - ace wraps, scissors…etc)
Yearly inventory and records must be maintained in both areas

14. Equipment Items that can be used for a number of years
Capital (remain in the athletic training facility including ice machine, tables)
Non-consumable capital (crutches, coolers, athletic training kits)

15. Additional Budget Considerations
Purchasing Systems
Direct buy vs. competitive bidding
Lease alternative
Additional Budget Considerations
Telephone and postage expenses
Utilities – heating/cooling, electricity
Contracts for outside services
Purchases relative to liability insurance and professional development

16. Developing a Risk Management Plan
Security Issues
Accessibility to athletic training clinic (staff, physicians, athletic training students)
Athletic training students must be supervised when in the clinical setting
Coaches may have access in secondary school settings
Fire Safety
Post evacuation plan in case of fire
Smoke detectors/alarm system and fire extinguisher should be tested and in place

17. Electrical and Equipment Safety
Major concern
Be aware of power distribution system to avoid accidents
Emergency Action Plan
Accessing emergency personnel outside setting in the event of emergency
Include transportation of athletes to emergency facilities
Meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care

18. Accessing Community Based Health Services
Must have knowledge of local and community health services and agencies in the event of referrals
Referrals should be made with assistance from a physician
Parental involvement is necessary when dealing with psychological and sociological events

19. Human Resources and Personnel Issues
Assembling appropriate personnel to achieve program goals and objectives is critical to success.
Recruitment, hiring and retaining qualified personnel is necessary to be effective
Specific policies are established relative to hiring, firing, performance evaluations and promotions
Must adhere to these principles

20. Roles and responsibilities must be established
Job descriptions - job specifications, accountability, code of conduct, and scope
Head athletic trainer must serve as a supervisor and work to enhance professional development of staff
Performance evaluations should take place routinely

21. Athletic Training Facility Design
Design will vary drastically based on number of athletes, teams, and various needs of the program
Size
Varies between settings
Must take advantage and manage space effectively
Interact with architect relative to needs of program and athletes

22. Location
Outside entrance (limits doors that must be accessed when transporting injured athletes)
Double door entrances and ramps are ideal
Proximity to locker rooms and toilet facilities
Light, heat and water source should be independent from rest of facility

23. Illumination Well lighted throughout
Reflective ceilings and walls will aid in process
Natural lighting is a plus

24. Special Service Areas
Treatment Area: area that accommodates 4-6 adjustable treatment tables, 3-4 stools, and hydrocollator and ice machine accessibility
Electrotherapy Area: area that houses ultrasound, diathermy, electrical stim units, storage units, grounded outlets, treatment tables and wooden chairs, under constant supervision

25. Hydrotherapy Area: area with centrally located sloping floor to drain, equipped with 2-3 whirlpools, shelving and storage space and outlets 5 feet above the floor
Exercise Rehabilitation Area: area that provides adequate space and equipment to perform reconditioning of injuries
Taping, Bandaging & Orthotics Area: 3-4 taping tables and storage cabinets to treat athletes with proximity to a sink

26. Physician’s Exam Room: space for physician to work which may hold exam table, lockable storage, sink, telephone
Records Area: space devoted to record keeping which may include filing system or computer based database, that allows access only to medical personnel

27. Storage Facilities
Athletic training facilities often lack ample storage space
Storage in athletic training room that holds general supplies and special equipment
Large walk-in storage cabinet for bulk supplies
Refrigerator for equipment, ice cups, medicine and additional supplies
Space should be designated for storage of patient belongings

28. Figure 2-2

29. Athletic Trainer’s Office
Space at least 10x12 feet is ample
All areas of athletic training facility should be able to be supervised without leaving office space (glass partitions)
Equipment should include, desk, chair, tack board, telephone, computer and independent locking system

30. Additional Areas
Pharmacy Area: separate room that can be secured for storing and administrating medications (records must be maintained concerning administration)
Rehabilitation Pool: if space permits, must be accessible to individuals with various injuries, with graduated depth and non-slip surface
Restrooms: Should be at least one available within the facility

31. Figure 2-1

32. Issues Specific to Athletic Training Program Operations in Clinic, Hospital Corporate of Industrial Settings
Staff must be prepared to provide care to a wide range of patients
Pediatrics
Adolescents
Young adults and adults
Geriatric patients
May also involve additional duties in management, marketing, outreach, along with fiscal and financial responsibilities

33. Scope of Practice Diverse patient population
In hospital settings time may be spent with in-patient, out-patient and/or ambulatory care
Owner of out-patient facility will dictate patient population seen at clinic
The AT may be involved with patient care, onsite employee fitness, ergonomics, work hardening programs, outreach programs, athletic event coverage
Limitations and restrictions will be dictated by state regulatory statutes

34. Location of Clinic
Patient base is critical and therefore location is key to attracting patients
Other factors
Zoning
Traffic concerns
Physician referrals
Will physicians use athletic trainers to provide services
Can the clinic provide additional services relative to industrial rehabilitation and workplace assessment
Sports medicine coverage for schools
Direct and indirect competition

35. Clinic Personnel and Human Resource Issues
Hours of Operation
Clinic will need to be opened at times that do not conflict with normal working hours
Early morning and evening hours
Weekend hours may also be useful
Clinic Personnel and Human Resource Issues
Athletic trainers will work with multiple healthcare provider in clinical/corporate and hospital treatment centers
Formal job descriptions are critical for all individuals working in environment
Communication and team approach is critical

36. Potential Athletic Training Duties
Ergonomic Assessment
Ergonomics is the science of designing products, machines and systems to maximize comfort, efficiency and safety
Based on anthropometry and biomechanics
Applied to industrial engineering
Used to design, adapt and alter workplace environments to accommodate to a person’s strengths, limitations, sizes and shapes
Primary goal often involves injury and accident prevention in workplace by minimizing risk factors
Postures, vibration, repetition & force

37. An athletic trainer may work with an occupational therapist or ergonomist to assess environment
Will provide assessment, make recommendations, provide instruction on injury prevention techniques
Report is generated and provided to site administrators with follow-up reviews often conducted to ensure implementation of recommendations
Figure 2-3

38. Work Hardening/Conditioning Programs
Intensive outpatient therapy for individuals injured on the job
Work conditioning = treatment 3 hours/day, 3 days/week
Work hardening = 8 hours of treatment daily, 5 days/week
Goal is to restore functionality and return to full duty capacity
Both an evaluation and report are assembled and are used to develop a rehabilitation plan

39. The evaluation involves:
Musculoskeletal examination (strength, posture, flexibility, gait, neurologic screening)
Functional capacity evaluation
Prolonged sitting, standing
Hand grip strength and lifting abilities
Ability to perform repetitive tasks
Carrying capabilities
Balance
These elements are continually monitored and allow for program adjustment in order to facilitate the patient’s return to appropriate levels of performance
Figure 2-4

40. Wellness Center
Athletic trainers may be involved in organizing wellness screenings and workshops for:
Asthma & diabetes
Hypertension & stroke
Cholesterol
Osteoporosis
Prostate/skin cancer
Designed for early detection, awareness and prevention
Programs designed to educate individuals on nutrition, health and safety may be offered
Health fairs are often an effective means of providing screenings and education

41. Community Outreach and Marketing
Some athletic trainers may be clinic or hospital based in the morning and may provide athletic training coverage in afternoons and evenings
Outreach may occur in the collegiate setting, secondary schools or for single athletic events
Serves as an effective marketing tool to promote and advertise clinic
Also provides visibility for the clinic to other healthcare providers and potential future consumers/patients

42. Corporate Fitness Programs
Involves in-house fitness programming for employees
Provides numerous health-related benefits to employees
Also serves to reduce health costs, increase productivity, reduce absenteeism, improve morale, lower healthcare expenditures and reduce sick leave
Often involves fitness screening and individual program design
Figure 2-5

43. Drug Testing Programs
Athletic trainers may be asked to oversee drug testing programs
Program may act as a deterrent to employees coming in unfit for duty
May be necessitated by federal guidelines or pre-employment screenings
Legal defensibility is the most important aspect of any drug-testing program
The corporation should use federally certified testing laboratories with all positive tests results confirmed via a medical review department

44. Fiscal Management
Having a basic understanding of business practices may be necessary in for-profit clinical settings
Knowledge of billing practices is critically important
Maintaining positive accounts payable vs. accounts receivable ratio is the goal of all successful businesses
Other responsibilities may include
Financial planning
Establishing contractual obligations
Efficient billing and collection systems
Budget formulation

45. Record Keeping Major responsibility
The rule not the exception - accurate and up-to-date
Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports

46. Maintaining Confidentiality in Record Keeping
Release of Medical Records
Written consent is required
Waiver must be signed for any release (include specifics of information to be released and to whom)

47. Health Insurance Portability and Accountability Act (HIPAA)
Regulates dissemination of personal history information (PHI) by coaches, AT’s, physicians or other members of sports medicine team
Guarantees athlete access to information and control over disclosure
Athlete may provide written authorization for release of information

48. HIPAA Authorization Description of information to be disclosed
Identification of parties authorized to provide and make use of PHI
Description of each purpose of the use or disclosure
Expiration date or event
Individual’s signature
Description of his/her authority to act for the individual if signed by personal representative

49. Family Educational Rights and Privacy Act
FERPA = law protecting privacy of student education records
Provides parents with certain rights with respect to child’s educational records
When child turns 18 rights are transferred to student
School must have written permission prior to releasing information

50. Administering Pre-participation Examinations
Initial pre-participation exam prior to start of practice is critical
Purpose is to identify athlete that may be at risk
Should include
Medical history, physical exam, orthopedic screening, wellness screening
Establishes a baseline
Satisfies insurance and liability issue

51. Examination by Personal Physician
Yields an in-depth history and ideal physician-patient relationship
May not result in detection of factors that predispose the athlete to injury
Station Examination
Provides athlete with detailed exam in little time
Team of nine is ideal (2 physicians, 2 non-physicians and 5 managers/student athletic trainers)

52. Medical History Physical Examination
Complete prior to exam to identify past and existing medical conditions
Update yearly and closely review by medical personnel
Collect medical release and insurance info at the same time
Physical Examination
Should include assessment of height, weight, body composition, blood pressure, pulse, vision, skin, dental, ear, nose, throat, heart, lungs, abdomen, lymphatic, genitalia, maturation index, urinalysis and blood work

53. Maturity Assessment Orthopedic Screening
Means to protect young, physically active athletes
Methods
Circumpubertal (sexual maturity)
Skeletal
Dental
Tanner’s five stage assessment is most expedient
Orthopedic Screening
Part of physical exam or separate
Various degrees of detail concerning exam

54. Sport Disqualification
Wellness Screening
Purpose is to determine if athlete is engaged in a healthy lifestyle
Sport Disqualification
Certain injuries and illnesses warrant special concern when dealing with sports
Recommendations can be made
American with Disabilities Act (1990)
Dictates that athlete makes the final decision
Potential disqualifying factors should be determined during the pre-participation exam

55. Personal Information Card
Contains contact information for family, personal physician, and insurance information
Injury Reports and Injury Disposition
Injury reports serve as future references
Reports can shed light on events that may be hazy following an incident
Necessary in case of litigation
All reports should be filed in the athletic training room

56. Treatment Log Sign-in to keep track of services
Daily treatments can be recorded
Treatment of daily therapies can be monitored along with compliance
Can be used as legal documentation in instances of litigation

57. Injury Evaluation and Progress Notes
Injuries and progress should be monitored by athletic trainer and recorded
SOAP note format
S: Subjective (history of injury/illness)
O: Objective (information gathered during evaluation)
A: Assessment (opinion of injury based on information gained during evaluation)
P: Plan (short and long term goals of rehab)

58. Supplies and Equipment Inventory
Managing budget and equipment/supplies is critically important
Inventory must be taken yearly in order to effectively replenish supplies

59. Annual/Seasonal Report
Summary of athletic training program functions
Can be used to evaluate recommend potential changes for program
Includes number of patients and types of injuries seen/treated

60. Computer as Tool for Athletic Trainer
Indispensable tool
Can make the job more efficient with appropriate software
Must maintain security
Must determine for what computer will be used

61. Should consult experts in order to determine what systems are appropriate for specific use
Factors to consider
Access to mainframe and internet
Hardware (desktop, laptop, personal digital assistants)
Software – various programs for multiple uses
Record keeping needs
Word processing, budget maintenance
Educational software
World Wide Web and access to

62. Collecting Injury Data
Accident - unplanned event resulting in loss of time, property damage, injury or death
Injury- damage to the body restricting activity
Case study- looks at specific incident of injury

63. Epidemiologic studies may assess various areas
Age or gender
Body part
Occurrence in different sports
Contact, non-contact, limited contact, collision sports

64. Catastrophic Injuries
98% of injuries requiring hospital emergencies are treat and release relative to sport
Sports deaths (struck with object, heat stroke)
Catastrophic injuries also include spinal cord trauma, cardiorespiratory injuries/problems
Most injuries are related to appendages
Strains, sprains, contusions, fractures, abrasions

65. Current National Injury Data-Gathering Systems
State of the art injury surveillance is still developing
Ideal situation involves epidemiologic approach
Epidemiology
Takes an evidence-based approach for identifying risk factors for injury and determining optimal treatment methods in clinical practice
Serves as foundation for intervention in interest of public health and preventive medicine
Extrinsic factors (activity, exposure, equipment)
Intrinsic factors (age, gender, neuromuscular aspects, structural aspects….etc)
Number of different surveillance systems in place

66. Surveillance Systems National Safety Council
General sports injury data
Annual Survey of Football Injury Research
Public school, college, professional, sandlot football injury data
National Center of Catastrophic Sport Injury Research
Tracks catastrophic injuries in all levels of sports

67. NCAA Injury Surveillance System
Data collected on most major sports- ATC data collection
Converted to web-based data collection system
National Electronic Injury Surveillance System
Monitor injuries relative to different products --consumer safety, determine if products are hazardous or defective

68. Using Injury Data
Valid and reliable data can be utilized to decrease injuries
May allow for:
Rule modification
Assist coaches and players in understanding risks
Help manufacturers
Educate parents, athletes and the public on inherent risks associated with sport